Gabapentin Withdrawal Symptoms
Yes, gabapentin can cause withdrawal symptoms, particularly after abrupt discontinuation or rapid tapering, especially in patients who have been on the medication long-term or at higher doses. 1
Evidence from FDA Labeling
The FDA label explicitly acknowledges gabapentin withdrawal, stating that there are "rare postmarketing reports of individuals experiencing withdrawal symptoms shortly after discontinuing higher than recommended doses of gabapentin," including agitation, disorientation, and confusion that resolved after restarting gabapentin. 1 Most affected individuals had a history of poly-substance abuse or used gabapentin to relieve symptoms of withdrawal from other substances. 1
The most frequently reported withdrawal reactions following abrupt discontinuation include anxiety, insomnia, nausea, pain, and sweating. 1
Guideline Evidence on Gabapentinoid Withdrawal
The Lancet Psychiatry (2019) public health review provides the strongest guideline-level evidence, establishing that:
Gabapentinoids (gabapentin and pregabalin) were initially believed to carry relatively low risk of dependence and withdrawal symptoms, but evidence now demonstrates that sudden cessation can lead to physical and psychological withdrawal symptoms. 2
Approximately 50% of patients receiving gabapentinoids had been treated continuously for at least 12 months, a practice of doubtful efficacy in many cases. 2
Patients treated long-term with gabapentinoids should be offered careful tapering and support if there is a decision to stop. 2
Clinical Characteristics of Gabapentin Withdrawal
Based on case reports and clinical evidence:
Withdrawal symptoms can occur after as little as 3 weeks to 1 month of treatment, though risk increases substantially with longer duration and higher doses. 3, 4
Symptoms typically begin 1-2 days after discontinuation and can include: 3, 5, 6
- Mental status changes (confusion, disorientation, agitation)
- Anxiety and restlessness
- Insomnia
- Somatic complaints (chest pain, headache)
- Akathisia (inner restlessness with motor movements)
- Flu-like symptoms
- Light sensitivity
- Hypertension
Withdrawal symptoms can occur even with gradual tapers (over 1 week), particularly in geriatric patients or those on chronic therapy. 5
Symptoms are unresponsive to benzodiazepines but resolve rapidly (within 1-2 days to 8 hours) upon reinitiation of gabapentin. 5, 6, 4
Tapering Recommendations
Gabapentin should be tapered slowly, similar to benzodiazepine tapering protocols—over weeks to months rather than days. 5
For patients with severe gabapentin dependence:
- Average reduction of 100 mg per month until reaching 300 mg daily. 7
- Slower taper of 20-30 mg decrements per month for doses between 100-300 mg. 7
- Very slow taper of 5 mg decrements every 1-2 weeks for the final 100 mg. 7
- Total taper duration may require 18 months or longer for patients with severe dependence. 7
Clinical Pitfalls to Avoid
Do not assume gabapentin is benign regarding withdrawal risk simply because it lacks significant drug interactions and has a favorable side effect profile. 3, 5
Do not use benzodiazepines to treat gabapentin withdrawal symptoms—they are ineffective; reinitiation of gabapentin is the appropriate treatment. 6
Do not taper gabapentin over just 1 week in patients on chronic therapy, even if this seems gradual—withdrawal can still occur. 5
Be particularly cautious in geriatric patients, who may develop more severe withdrawal symptoms even with gradual tapers. 5
Recognize that withdrawal risk exists even at therapeutic doses (not just supratherapeutic doses), particularly with chronic use. 3, 7, 5
Adjunctive Use in Opioid Withdrawal
Notably, gabapentin has been used as an adjunctive medication to help decrease opioid withdrawal symptoms during opioid weaning, though this is an off-label use. 2 This does not negate gabapentin's own withdrawal potential.